Hayes, Vincella Louise Pine View Cemetery g Crematorium
Quaker Road
Queensbury, NY 12884
(518) 745-4477 or (51 a) 745-4476
FUNERAL HOME: �)nv�
"- dfF,YIt.NQki _-.--.—,_ _ , RETURN TIME: _
DATE A TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR REGgISTEREp RESIDENT DELIVERING REMAINS:
NAME: . ___.
L�'�' CASE E
TYPE OF CONTAINER: _— •-•.aEL •V•�- /�eIJYa /
PLACE OF DEATH:
ESTIMATED WEIGHT OF REMAINS A CONTAINER____
1 �2iE
PLACED IN HOLD: y
PLACED IN REFRIGERATION: _ g_SD R11
DATE OF CREMATION: T--
e�:
TIME STARTED: ,_—--AlP6gn---_TIME COMPLETED: _ ISCPI'I
PLACED IN RETORT: ����� p^
---MDVED: ------'L,�f lL,Srn RETORT N IN WHICH REMAINS WERE CREMATED:
1-oof 4
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATE THAN 48 RS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL HE neinwEO W THE PERMANENT FILE OF THE CREMATOR
af— //////------------111111 OaPeMn coulees
EWYORK Division of OMSIOX OFCEMEIERIFS
STATE OF One C"riw"Waze
uP RNNITy. Cemeteries "weld„conik"°,w
223ma"
hi Seawall
Authorization for Cremation and Disposition
This Autnonaacon Form must be completed add signed prior to delivery OI mmam be CCMmatlan.
Date: O&llaO20 Number:
larematwy Nam: Pine View CMMaOry
pool 21 Ouaker Rd Quesionall NY 12804 phone sit 7
CREMATION IS AN IRREVERSIBLE AND RIVAL PROCESS.
Cremation is lined oil by gadn8 ale remains of Me deww9e and the uxlMirer boiling the remains into vein Wn chamber where
May are subieclee to intense Mel and flame. The hog and Blame will Incinerate and consume everything Rcept borre and mass,
which am all that all be left after cmMagOn.
FdW in9cremation, Pe mematory will take regonabb etlorbb remove all ofine remains and other Malay hom the Cremation
chamber bar some minimal dust and residue tall hardly he e8 Lm" The Crematary will separate ircieerlbl and benign hall firtan
Its remage;and me'mckental and bri mmolll will M disposed of as natural by law. The CremNed nmairs hall M micson'Ically
puNemid Into small pieces and plated Into a designated annual rum. CmMMd nmalm pananlly am Wlv@r" MITIm
single bagmen b ram9nlmbse as 3ke l Ussum
OPENING OFTHE CONTAINER
Life chromium may Only open the wMamer holding Me uncremated human remains in limited oramstanws, such as to confirm She
itlentity oft"demanded or to ensure Met no material is ewom which might Mine emPic"FaS OF damage the crtmalory pmWmp Is
human remains are delivered in a container which b net suftW ter cnmaticn Such as compound or mnbl"Ska4
nmatary will require that the norms be moved inro a suitable container Mom it accepts We r ins. The Opening Ia
l ambda or the tmnskr or remMal of repel has III be vnduC0.tl Mort a wMess and will be done ing Ali with tlignTy and Florida
IDENTIFICATION OF DECEASED
Name Of Decamped: V'nolila Louse Hayes Merged St she Mametl
Lan grown Armed; 216 Valentine Pond Road Pdllmsville, NY 12NO
Ram of 0acto Glens Falls HCSPa 1, 102 Perk Street, Glens Fells, NY 12801
So-: IN ® F Age: 77 DOB: 121161i OM of Deal: Il&(IBI2020 Eetirnated Weigh: 140
Din oon U wNegxnginer in wN remdln III be with
Florence Casket-Deluxe CorReiner
ERSON IN CONTROL OF O SP0SMON
(Pmson(a)In ro frd NdsMa1i w. L ONE or the arwing)
I emits are Me h Qmtetl ages Of Me deceaw designated In awilI or wroon insWmel executed pursuant W Public
Health law Sector 4201.
-OWL
k4l INle have no kMwledge that the charged executed 8 Witten lnsburrent Nmuanlm Public Health Los Damon 4201 Ora
will oanoweri lg dimalans ter Me didpovitian of his Or her remains and lure are Me Pempnlsl having Worry under Pudic Hants Law
Bedkn 4201 and have The right by aulMnde cremation of Me remains d the de¢aad. N XDw mlatioM ip to day deceased h as
blows:
Vncella Louise Hayes
DOB-18984(Rev. DIMNO) Paget of
Authorization for Cremation and Disposition
ormart/2vn the lM below)
Number ppseepEon:Survivinat Sompre
t A person designated In wrung pursuant to Poetic Hisma Law SB[4on<901(311
2. The euMNrg spavae:
]a. The wrvlwn9 ecmenm prover:
a Any wmmng cold common years of age or oeer',
0. Asurviving pram
IT A surviving siblirg eighteen were of age or alder
(L A lawfully appointed personl
T. Any rempar l forever years of age Or older ntnkd to share In Me ealete Ohio who Were eastern relationship ao the deceased:
a. A duly appe ineed fiduciary of Me estate)
9. Aclose Mend or reentive who has eucWd a writlen statement pursuant To Public Health taw Section 0201py,
10. Achief fecal oRrcer of a muddy or a pudic OdminWator appointed Wrauant to the 5unopabh Cord Pm Mure Me
10a. My other persm who is acting on behalf of Me command and who has execudd a written sebmaM Owsuentb Public Heats
Law senan Azm(7),
(In✓Menl ALL THREE a Xre Am wMg)
.aaW—W/e hereby whom Mat the body of the deceased does nth certain a many, battery peek, power cell indicative implant
or nomexprve device and Mat any sots materah were removM poor to the execution Wtho Au HMWn Ferm. FallumtommmS
these dame prior cremation may result in harm to and cnmatwy and cremel graanml.
�IAnse aRnm that assumptions have barn given to David Alexander
regarding the removal W any personal properly or other MiN aha ve which any pennon signing below an any family member of the,
deceased wishes to preserve. Pine View Crematory
9 not remember M Me removal M pe%ml Rams Rain Me wMaiow or upn the remains of Me deceased. Pareopal Xame Me in Its
coonpnpWpmr or with the remdma bolt be dasboyad by Yre cMMe praceae and can not be reirieved adds aremallan.
bWa hereby authorise Pine Vim Crematory
xma wcmm2wl mmalmaf Yredecwed
(mile OPTIONAL)
IIm hereby authariu Me named funeral dlrectw to Provide he deliveryTO sod crema0on by an allmaN
nmafory, if deemed necessary In the opinion of the fwmrat dimmer,and W amend Mia form A provide Me worm name and
address of such atttmaM mmabry.
FINAL DI9 aP4RIOX
The peso devrized to restive the crcmaMl remains of Me deceased from Me cremafary'a:
Name:Alexander-Baker Funeral Home, David Alexander
Addreap: 3809 Main Street Warrensburg NY 12885 Phone: (518) 6234085
The uemaMd remains of deceased will be disposed was follows
Return to family
Xbr am rearm the person named above deep not Aso possession ofMe crerteMd remase.
Pine View Crematory is auMa to give possession of
f"mai
the remains AlexanderAaker Funeral Home by delivery
in person or icy nag odd man. Yncri Louise Hayes
evemmosswo
DOS-189Mfev. Cited)
(R Fye3IXa
Authorization for Cremation and Disposition
mmnd the fiammgl
K.P/1 lNe understand Nat it the remains ere not named!man 120 am of cremation,
Pine Vim Crematory may dispose of Me wheirein
coos
an irteNevebla manrer, such mby¢catlenrg.
CREMATION CONTAINER RN
(tn�UWONEothe serving)
KR//�( Pn um to be used as a container i the aemned remains has been purchased fromAlexander-Baker Fu drat
and 'a descnbed as Whose Photo Urn
INIe uMmtand that it Me um is be,annowl to red Me entire aemabd famous,an addponal nand ccrteiose may be used for m ery.
An um is not yet automated. INM understand Mat if no um is purchasM or otherwise prvi
Pine Vim Crematory will pleas the venWed ramelna in
weedca "n
a rigid tampanry mnbinar for delivery.
This material Form was provided by David Alexander "a sayouted at
Alexander-Baker Funchal Home
3 WMain Sheet Warrensburg NV UNIT
er inn a and is signed by Me formed diredorMy w oness to its execution
INJe have hmm"d a completed copy of this Authorization Farm.
The personals)Idantmed below imam the peaontet in Control of dissolution,wiled by signing this Authorization Form, atuegal
to the accuracy and completeness of the Information contained in this Authorization Form and Methane Me mra lea.
6iarwd this 11111 day of August .20 20 A ,,
Kenneth R. Hayesr4
216 Valentine Patd Road, Poaemville, NV 12660
WITNF%9:
David Alexander
psi n,i..«.,wada.warema
10034
Vrlcella Louise Hayes
Iaswnwr
DOS WWI does,Mill Postal